The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting.

Size: px
Start display at page:

Download "The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting."

Transcription

1 The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting. { Thalia Petropoulou, Clinical Fellow Paul Hainsworth,Colorectal Surgeon Prof Alan Horgan,Colorectal Surgeon Freeman Hospital, NUTH

2 Enhanced Recovery: the evidence Hospital stay ERAS vs Traditional days ERAS versus Traditional Care in Colorectal Surgery 13 Studies, 1910 patients Total complications 0.71 RR Readmission rate Mortality No difference Zhuang et al, DCR 2013

3 ERAS The Evidence Increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome (ERAS Compliance Group, Ann Surg Jun;261(6): Accelerated discharge within 72 hours of elective colorectal resection for cancer is safely achievable for the majority of patients without compromising short-term outcome (Emmanuel et al, Ann R Coll Surg Engl )

4 In this large, multi-institutional North American data registry, high adherence to ERPs was associated with earlier recovery, decreased complications, and shorter LOS. ERPs can improve outcomes; however, benefits correlate with adherence. Adherence to Enhanced Recovery Protocols in NSQIP and Association With Colectomy Outcomes (Berian et al, Annals of Surgery 23 October, 2017) 8139 elective colectomies at 113 hospitals { LOS 4.3 days (high adherence) vs 7.8 days low adherence; P < ). High-adherence patients achieved recovery milestones earlier (with return of bowel function at 1.9 (vs 3.7) days, tolerance of diet at 2.4 (vs 5.4) days, and oral pain control at 2.7 (vs 5.0) days (P < )

5 Prolonged Postoperative Ileus (PPOI) PPOI remains a significant clinical problem in patients undergoing advanced pelvic cancer surgery (about 30%), despite the increased awareness and implementation of enhanced recovery protocols. New regimens for better prophylaxis are needed, and further research on POI treatment is important. (Funder et al, J Surg Res Oct;218: ) Prolonged ileus is a common condition following colon resection, with an incidence of 12.7% and its worst in right sided colectomies- NSQIP databases total of 27,560 patients (Moghadamyeghaneh et al, Surg Endosc Feb;30(2):603-9

6 Methods to reduce POI Methods to prevent-reduce POI are needed (ERAS Society World J Surg (2013) 37: , SAGES-ASCRS Diseases of Colon and Rectum Volume 60: 8 (2017)) Intraoperative optimazation and reduce opioids regular diet immediately Alvimopan Chewing gum Laxatives

7 Laxatives Bulking agents Stimulant agents Osmotic agents Stool softeners Used for stimulate gut motility and reduce constipation(1) Use in chronic constipation and in opiod induced constipation(2) Use in eras protocols to stimulate gut motility and reduce LOS 1(MedGenMed. 2007; 9(2): 25, Review of the Treatment Options for Chronic Constipation, John F. Johanson) 2. (BMJ Clin Evid Apr 6;2010. pii: 2407, Constipation in people prescribed opioids, Ahmedzai SH, Boland J )

8 Laxatives can reduse the length of hospital stay in colorectal surgery as and in non colorectal surgery Gianpiero Gravante and Muhammad Elmussareh World J Gastroenterol Jan 21; 18(3):

9 Laxatives and LOS- The evidence * Management of postoperative constipation in anorectal surgery. (Dis Colon Rectum Apr;22(3):149-51, Corman ML et al. -> Laxatives help with post-op constipation *Bowel function after minimally invasive urogynecologic surgery (improves with docusate sodium) : a prospective randomized controlled trial. (Female Pelvic Med Reconstr Surg 2012, Mar-Apr:18(2)82-85 McNanley A1, Perevich M, Glantz C, Duecy EE, Flynn MK, Buchsbaum G)

10 Laxatives and effect on LOS Bisacodyl in radical hysterectomy can reduce LOS of 1day (Ramiraz et al, World J Surg 2013, 37: Role of magnesium salts in early normalisation of gut motility after hepatic resection-> 1 day reduction of LOS (Basse L et al, BJS 2001, 88:

11 Laxatives and stimulation of gut motility- The evidence Reduce of constipation with lactulose, docusate and senna, without increasing side effects (Can Oncol Nurs J Autumn;23(4):236-46) Efficacy and side-effect profiles of lactulose, docusate sodium, and sennosides compared to PEG in opioid-induced constipation: a systematic review. Ruston T, Hunter K, Cummings G, Lazarescu A

12 Laxatives and stimulation of gut motility- The evidence *Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (World J Surg (2013) 37: ) Prevention of postoperative ileus (including use of postoperative laxatives) Evidence level (chewing gum, alvimopan, laxatives (magnesium): Medium/ Low Recomedation grade: Weak *Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (DISEASES OF THE COLON & RECTUM VOLUME 60: 8 (2017) - Alvimopan and chewing gum: Recommendation 1A

13 Our Study Prospective observational study Includes all patients undergoing elective uncomplicated, colorectal resections, without stoma formation between 08/15 to 08/17. Hypothesis: use of laxatives could reduce the LOS without increasing complications 2 groups. 100 pts in group A, 120 patients in Group B Pre and intraoperative management was the same for both groups Postoperative, in group A we added the use of laxatives (docusate 100 mg BD) from post day 1. No laxatives in group B Primary end point was the LoS in each group. Secondary end point was the post-operative complication rate. Pt with complications excluded from the analysis of LoS

14 Intra-op Pre-op Post-op Remove urinary catheter OUT ON DAY 1 UNLESS RECTAL SURGERY (day 2) The protocol Antibiotics prophylaxis No premedication Anesthesia protocols Laparoscopic surgery Active warming Perioperative fluid management Control blood glucose PONV prophylaxis Thromboprophylaxis Education and counselling Nutritional assessment and support Cardiopulmonary function evaluation No bowel preparation Drink clear fluids till 2 hrs pre op Carbohydrate drinks No nasogastric tube UNLESS NECESSARY Prevention of stress ulcer Omeprazole 20 mg Multimodal analgesic approaches Paracetamol 1 gr TDS Ivuprofen 400 mg TDS, 200 mg PRN (max 2400 mg) Tramadol 100 mg PRN PCA (Yes/No) OUT ON DAY 1-2 IN LAP OR 3 IN OPEN Epidurall (Yes/No) OUT ON DAY 1-2 IN LAP OR 3 IN OPEN Early oral intak Oral Fluid (mls in 24 hours) Nutritional support Two high protein/ calorie drinks on operation day Three high protein/ calorie drinks per day from post-op days 1 to 3 Early Mobilisation/Time out of Bed (hrs in 24 hrs) Prevent of PONV cyclizine ondacentron Stimulate of gut motility Laxido (Yes/No) COMMENCE ON DAY 1 Remove drain tubes Stop IVT Day 1

15 Group A Lap Right Lap Left Open Stoma

16 Group B Lap Right Lap left Open Stoma

17 { { Group A 100 patients overall median LOS was 4 days (range 2-6) lap right resections 3 days lap left sided resections 4 days open/complicated resections, 6 days Group B 120 patients overall median LOS was 5 days (range 2-7) lap right resections 5 days lap left sided resections 5 days open/complicated resections, 6 days Statistically significant difference in LoS was found in all subgroup analysis (p<0,001), except the open/complicated resections (p=.931)

18 Results The complication rate was 16% for the first group and 18,3% for the second group, but this was not significantly different between groups (p=.64)

19 Type of surgery Lap Left Sided Colectomies Lap Right Sided Colectomies Open/ Complicated Resections All Resections Complicatio n Rate (%) Group A (100 pts) LOSH (Days- Mediam) Group B (120 pts) LOSH (Days- Mediam) P- Value (Mann- Whitney U test) 4 5 < < < < (x square test)

20 Results 8 pts from Group A went home on post-op day 2 No one from Group B went home on post-op day 2 No pts from Group A, went home on day 7 6% PPOI in Group A VS 15% in Group B

21 Conclusions * Use of laxatives from the first post-operative day, may be a safe and effective measure to reduce LoS in patients undergoing uncomplicated elective colorectal surgery, without stoma formation The reduce in LOS is greater in pts undergoing right sided resections No evidence to suggest that their use can affect anastomotic dehiscence * Further studies and RCT s are necessary in order to establish their use and gain the benefits

22 Thank you

Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus

More information

Operational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy

Operational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD

More information

ERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic

ERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track

More information

Enhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Enhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid

More information

R Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore

R Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,

More information

Laparoscopic Colorectal Surgery

Laparoscopic Colorectal Surgery Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment

More information

ANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist*

ANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Enhanced Recovery after Colorectal Surgery Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Clinical Emergency Hospital of Bucharest, Romania *Karolinska Institute, Stockholm, Sweden ERAS - Enhanced

More information

7/31/2015. Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice. Objectives. Enhanced Recovery Society

7/31/2015. Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice. Objectives. Enhanced Recovery Society Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice Margaret Odhner MS, ANP-BC, COCN Kim Meacham, MSN FNP-C, CWON Objectives 1. Describe the Enhanced Recover After Surgery (ERAS) pathway.

More information

Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings?

Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings? Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings? Kate Willcutts, DCN, RD, CNSC University of Virginia Health System Charlottesville, VA kfw3w@virginia.edu Objectives 1. Discuss

More information

Chirurgia del Colon in Week Surgery?

Chirurgia del Colon in Week Surgery? Chirurgia del Colon in Week Surgery? dr. V. Fiscon dr. G. Portale Chir. Generale, Cittadella -PD- ULSS 6 Euganea E il colon??? Kraft K et al., J C Visc 2013 Discharge early Colon in week surgery Readiness

More information

ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY

ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY Department of Surgery Divison of General Surgery ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY December 2016 Disclosure Paresh

More information

Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital

Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine

More information

Simone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs

Simone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs Impact of an ERAS Colorectal Program on clinical outcomes and costs Simone Targa U.O. di Clinica Chirurgica Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna ERAS Protocol ENHANCED RECOVERY

More information

Enhanced Recovery after Surgery

Enhanced Recovery after Surgery Enhanced Recovery after Surgery AKA ERAS What is Enhanced Recovery (ER)? Paradigm shift in surgery and surgical care of the patient Philosophy of care Perioperative continuum Multidisciplinary Patient

More information

Multimodal Approach for Managing Postoperative Ileus: Role of Health- System Pharmacists (ACPE program H01P)

Multimodal Approach for Managing Postoperative Ileus: Role of Health- System Pharmacists (ACPE program H01P) 1. In the normal gastrointestinal tract, what percent of nutrient absorption occurs in the jejunum? a. 20%. b. 40%. c. 70%. d. 90%. 2. According to Dr. Erstad, the four components of gastrointestinal control

More information

Nutritional Support in the Perioperative Period

Nutritional Support in the Perioperative Period Nutritional Support in the Perioperative Period Topic 17 Module 17.6 Facilitating Oral or Enteral Nutrition in the Postoperative Period Mattias Soop Learning Objectives To review the causes of postoperative

More information

ANICOLAU.RO. What is ERAS? Enhanced Recovery After Surgery. A.E.Nicolau*,Irina Grecu** Spitalul Clinic de Urgenta

ANICOLAU.RO. What is ERAS? Enhanced Recovery After Surgery. A.E.Nicolau*,Irina Grecu** Spitalul Clinic de Urgenta Spitalul Clinic de Urgenta ANICOLAU.RO What is ERAS? Enhanced Recovery After Surgery A.E.Nicolau*,Irina Grecu** *Clinica de Chirurgie **Clinica de Anestezie Terapie Intensiva ERAS = Fast-track surgery

More information

If you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4

If you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4 A large body of clinical evidence* demonstrates If you reduce variability in volume administration, you can reduce post-surgical complications, LOS and associated costs 1-4 Complications Too Dry Too Wet

More information

Fluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017

Fluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 Fluid Balance in an Enhanced Recovery Pathway Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 No Disclosures 2 Introduction The optimal intravenous fluid regimen

More information

Enhanced Recovery After Surgery Getting it Right

Enhanced Recovery After Surgery Getting it Right Enhanced Recovery After Surgery Getting it Right Aalok Agarwala, M.D., M.B.A. Division Chief, General Surgery Anesthesia Associate Director, Quality and Safety, MGH DACCPM Assistant Professor, Harvard

More information

Educational Learning Objectives. Evidence into Practice. Audience. Case Presentation. Outline. Multimodal Approach to Colorectal Surgery

Educational Learning Objectives. Evidence into Practice. Audience. Case Presentation. Outline. Multimodal Approach to Colorectal Surgery Educational Learning Objectives Multimodal Approach to Colorectal Surgery Value and Impact of Nutrition Interventions May 5, 2011 Dr. Corilee A. Watters, MSc, RD, PhD, CNSC Asst. Prof, Nutrition, University

More information

Creating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination

Creating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination Creating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination Jason D. Sciarretta, MD, FACS Grand Strand Medical Center, Myrtle Beach, SC University of South Carolina

More information

Optimising Perioperative Pain Management And Surgical Outcomes

Optimising Perioperative Pain Management And Surgical Outcomes Optimising Perioperative Pain Management And Surgical Outcomes Dr Chew Ghee Kheng MBBS FRCOG MD FAMS Senior Consultant Gynaecologist Subspecialist in Gynaecology Oncology Surgery Singapore General Hospital

More information

Fast-Track Colonic Surgery: Status and Perspectives

Fast-Track Colonic Surgery: Status and Perspectives Fast-Track Colonic Surgery: Status and Perspectives Henrik Kehlet H. Kehlet ( ) Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk

More information

Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience

Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC Our Data Experience No Disclosures 1/26/2015 2 Purpose To tell our story of how we collect and share our ERACS data 1/26/2015

More information

Randomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer

Randomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer Original Article Randomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer Sukanya Wiriyakosol, Youwanuch Kongdan, Chakrapan

More information

Postoperative Ileus. UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011

Postoperative Ileus. UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Postoperative Ileus UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Hobart W. Harris, MD, MPH Introduction Pathophysiology Clinical Research Management Summary Postoperative Ileus:

More information

ERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland

ERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published

More information

Current evidence in acute pain management. Jeremy Cashman

Current evidence in acute pain management. Jeremy Cashman Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side

More information

Perceptions of the application of fast-track surgical principles by general surgeons

Perceptions of the application of fast-track surgical principles by general surgeons The Royal College of Surgeons of England AUDIT doi 10.1308/003588406X94940 Perceptions of the application of fast-track surgical principles by general surgeons CATHERINE JANE WALTER, ADRIAN SMITH, PIERRE

More information

Disclosures. I am a paid consultant for:

Disclosures. I am a paid consultant for: Surgical Sub-specialization: Colorectal Specialist Peter W. Marcello, M.D. Vice Chairman, Department of Colon & Rectal Surgery Lahey Clinic Burlington, Massachusetts Disclosures I am a paid consultant

More information

Prevent gastric distention and vomiting after surgery

Prevent gastric distention and vomiting after surgery Remove toxic and unwanted substances from the stomach Administration of enteral nutrition, drugs and so on It favors lung expansion in mechanically unconscious and ventilated subjects Aspiration gastric

More information

TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial

TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial Kim Gorissen Frederic Ris Martijn Gosselink Ian Lindsey Dept of Colorectal Surgery Dept of

More information

To staple or to sew. Zeng Xuan Hu

To staple or to sew. Zeng Xuan Hu To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress

More information

Welcome Charles Kennedy

Welcome Charles Kennedy Welcome Charles Kennedy Comoderators Girish P. Joshi, MBBS, MD, FFARCI Professor of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas, Texas David E. Beck, MD, FACS

More information

Index. Enhanced Recovery in NSQIP (ERIN), 240 Epidural analgesia, 149 Epidural-induced hypotension (EIH) management, ERAS

Index. Enhanced Recovery in NSQIP (ERIN), 240 Epidural analgesia, 149 Epidural-induced hypotension (EIH) management, ERAS A Abdominal surgery ERP carbohydrate treatment, 46 comprehensive guide, 258 crystalloid-based perioperative fluid therapy, 120, 122 insulin resistance, 64, 169 laparoscopic order sets, 269, 274 278 laparoscopic

More information

Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children

Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Jeremy D. Kauffman MD, Paul D. Danielson MD, Nicole M. Chandler MD Johns Hopkins All Children s

More information

Presentation at ACS NSQIP National Conference in July Surgical Site Infection Reduction Strategies

Presentation at ACS NSQIP National Conference in July Surgical Site Infection Reduction Strategies Presentation at ACS NSQIP National Conference in July 2015 Surgical Site Infection Reduction Strategies PeaceHealth Sacred Heart Medical Center at RiverBend Level II Trauma Center 379 Beds 15,060 cases

More information

Disclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies

Disclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies Personalized Approaches to Gastrointestinal Cancers Emily Groves, MD Colorectal Surgery Assistant Professor, Division of Surgical Oncology Disclosures None Objectives What is personalized medicine and

More information

Improving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot

Improving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot Improving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot Julia R. BerianMD; Kristen A. Ban MD; Sanjay MohantyMD,MS; Jennifer L. ParuchMD,MS; Clifford Y. KoMD,MS,MSHS; Julie K. Thacker

More information

Identifying Characteristics Associated with Ileus Development Post Coronary Artery Bypass Graft Surgery

Identifying Characteristics Associated with Ileus Development Post Coronary Artery Bypass Graft Surgery University of Nebraska Medical Center DigitalCommons@UNMC Theses & Dissertations Graduate Studies Summer 8-19-2016 Identifying Characteristics Associated with Ileus Development Post Coronary Artery Bypass

More information

Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational study

Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational study Research Journal of the Royal Society of Medicine Open; 2015, Vol. 6(2) 1 5 DOI: 10.1177/2054270414562983 Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational

More information

Antidiarrheals Antidiarrheal

Antidiarrheals Antidiarrheal Antidiarrheals Major factors in diarrhea Increased motility of the GI tract. Decreased absorption of fluid. Antidiarrheal drugs include: Antimotility agents. Adsorbents. Drugs that modify fluid and electrolyte

More information

Colorectal Surgery in the Elderly. Stephen Smith

Colorectal Surgery in the Elderly. Stephen Smith Colorectal Surgery in the Elderly Stephen Smith Scope WHO >65 Social definition No COI Age specific incidence of CRC in Australia 2016 (new cases/100,000) My data: elective bowel resections

More information

1 of 5. Integrated Order Set Inpatient, Adult. Gynecological Surgery Enhanced Recovery Orders apply to patients 18 years and older.

1 of 5. Integrated Order Set Inpatient, Adult. Gynecological Surgery Enhanced Recovery Orders apply to patients 18 years and older. Orders apply to patients 18 years and older. All preprinted doses are based on normal renal and hepatic function and must be assessed for adjustment against the individual patient s renal and hepatic function

More information

ESPEN Congress Vienna Nutrition after discharge from hospital: The surgeon s responsability. O. Ljungqvist (Sweden)

ESPEN Congress Vienna Nutrition after discharge from hospital: The surgeon s responsability. O. Ljungqvist (Sweden) ESPEN Congress Vienna 2009 Nutrition after discharge from hospital: The surgeon s responsability O. Ljungqvist (Sweden) Nutrition after discharge from hospital: The surgeon s responsability Olle Ljungqvist

More information

Development and Utilization of Standardized Hip Fracture Guidelines

Development and Utilization of Standardized Hip Fracture Guidelines Development and Utilization of Standardized Hip Fracture Guidelines Sally Knight RN Clinical Quality Nurse Lori Smith RN Clinical Quality Nurse Deborah Newall RN Orthopedic Program Coordinator Wallace

More information

Intro Who should read this document 2 Key practice points 2 What is new in this version 3 Background 3 Guideline Subsection headings

Intro Who should read this document 2 Key practice points 2 What is new in this version 3 Background 3 Guideline Subsection headings Enhanced Recovery for Major Urology and Gynaecological Classification: Clinical Guideline Lead Author: Dr Dominic O Connor Additional author(s): Jane Kingham Authors Division: Anaesthesia Unique ID: DDCAna3(12)

More information

Evaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University Hospital

Evaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University Hospital Med. J. Cairo Univ., Vol. 85, No. 5, September: 1911-1916, 2017 www.medicaljournalofcairouniversity.net Evaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University

More information

Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better!

Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better! Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better! Francis Seow- Choen Medical Director Seow-Choen Colorectal Centre Singapore In all situations: We have to use the right tool for the job

More information

Enhanced Recovery After Discharge: does it happen?

Enhanced Recovery After Discharge: does it happen? Enhanced Recovery After Discharge: does it happen? Nader K Francis ERAS-UK Southampton 14 th November 2014 BJS 2014 Functional / symptoms Length of hospital stay 37 Readmission 29 Pain 16 Fatigue 9 BJS

More information

Early Recovery after Surgery (ERAS):

Early Recovery after Surgery (ERAS): Early Recovery after Surgery (ERAS): Applying Consistently What We ve Known for 20 Years Dr. Kurt Heiss, MD Objectives Laying Foundation: Who, Why Explore Components: What Start a Program: How and When

More information

Original article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery?

Original article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery? Gastroenterology Report 1 (2013) 138 143, doi:10.1093/gastro/got008 Advance access publication 4 April 2013 Original article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic

More information

EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES

EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES Clifford Ko, MD, MS, MSHS, FACS, FASCRS Professor of Surgery UCLA Director, ACS NSQIP, American College of Surgeons EVIDENCE Ban

More information

ERAS Protocol: Pancreatic Surgery

ERAS Protocol: Pancreatic Surgery ERAS Protocol: Pancreatic Surgery PANCREATICODUODENECTOMY Versione del protocollo: giugno 2012 Team Coordinatore: Ospedale San Raffaele Milano Referenti: Chirurgo Dr. Gianpaolo Balzano e-mail: balzano.gianpaolo@hsr.it

More information

DIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV

DIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical

More information

Nerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS

Nerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV

More information

Vincent James Obias, MD MS

Vincent James Obias, MD MS Vincent James Obias, MD MS Education Undergraduate B.S., James Madison University, 1989-1993 Graduate/Medical Education Masters of Science, Medical College of Virginia/Virginia Commonwealth University,

More information

Impact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length of Stay in Laparoscopic Colorectal Surgeries

Impact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length of Stay in Laparoscopic Colorectal Surgeries Journal of Pharmacy and Pharmacology 4 (2016) 521-525 doi: 10.17265/2328-2150/2016.10.001 D DAVID PUBLISHING Impact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length

More information

The Binational Colorectal Cancer Audit. A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017

The Binational Colorectal Cancer Audit. A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017 The Binational Colorectal Cancer Audit A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017 Binational Colorectal Cancer Database 2010 First Patient 2011 Contract between CMUDS and

More information

Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery

Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery 12 Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery L Ndayizeye, A K Kiswezi University Teaching Hospital of Butare, Rwanda. Correspondence

More information

FAST TRACK MANAGEMENT OF PANCREATIC CANCER

FAST TRACK MANAGEMENT OF PANCREATIC CANCER FAST TRACK MANAGEMENT OF PANCREATIC CANCER Jawad Ahmad Consultant Hepatobiliary Surgeon University Hospital Coventry and Warwickshire NHS Trust Part 1. Fast Track Surgery for Pancreatic Cancer Part 2.

More information

LONG TERM OUTCOME OF ELECTIVE SURGERY

LONG TERM OUTCOME OF ELECTIVE SURGERY LONG TERM OUTCOME OF ELECTIVE SURGERY Roberto Persiani Associate Professor Mini-invasive Oncological Surgery Unit Institute of Surgical Pathology (Dir. prof. D. D Ugo) Dis Colon Rectum, March 2000 Dis

More information

University of Groningen. Colorectal Anastomoses Bakker, Ilsalien

University of Groningen. Colorectal Anastomoses Bakker, Ilsalien University of Groningen Colorectal Anastomoses Bakker, Ilsalien IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document

More information

Robotic Ventral Rectopexy

Robotic Ventral Rectopexy Robotic Ventral Rectopexy What is a robotic ventral rectopexy? The term rectopexy refers to an operation in which the rectum (the part of the bowel nearest the anus) is put back into its normal position

More information

Enhanced Recovery After Surgery (ERAS)

Enhanced Recovery After Surgery (ERAS) Enhanced Recovery After Surgery (ERAS) Brad White, D.O. Anesthesiology Residency Program Director Oklahoma State University Medical Center Assistant Clinical Professor of Anesthesiology Oklahoma State

More information

Per-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson

Per-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson 2326 LIVER Per-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson Department of Surgery, Clinical Sciences Lund, Skåne University Hospital

More information

The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page

The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5122-5129 Enhanced Recovery Program (ERP) versus Traditional care after Elective Left Side Colorectal Cancer Surgery Ahmad Aboelkassem

More information

Analgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital

Analgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic

More information

Fast Track Colorectal Surgery A new era of perioperative care. Jauch, LMU Grosshadern,, Munich

Fast Track Colorectal Surgery A new era of perioperative care. Jauch, LMU Grosshadern,, Munich Fast Track Colorectal Surgery A new era of perioperative care P. Rittler,, Karl-Walter Jauch, LMU Grosshadern,, Munich FAST Track = ERAS(Enhanced Enhanced Recovery After Surgery) ) = Multimodal Rehabilitation

More information

Primary Care Constipation Guidelines. Version 1 November 2016

Primary Care Constipation Guidelines. Version 1 November 2016 Primary Care Constipation Guidelines Version 1 November 2016 VERSION CONTROL Version Date Amendments made Version 1 November 2016 New guideline Contents 1. Management of constipation in adults: acute and

More information

Achieving 23 hour hospital stay after colorectal resection. Professor Tim Rockall, Guildford, UK

Achieving 23 hour hospital stay after colorectal resection. Professor Tim Rockall, Guildford, UK Achieving 23 hour hospital stay after colorectal resection Professor Tim Rockall, Guildford, UK History Outcomes from open colorectal surgery 10 to 14 days in hospital 10% wound infection 2-10%+ anastomotic

More information

RECENT ADVANCES IN ANALGESIA

RECENT ADVANCES IN ANALGESIA 4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria

More information

Emergency thoracic surgery. Tim Batchelor Department of Thoracic Surgery Bristol Royal Infirmary

Emergency thoracic surgery. Tim Batchelor Department of Thoracic Surgery Bristol Royal Infirmary Emergency thoracic surgery Tim Batchelor Department of Thoracic Surgery Bristol Royal Infirmary Introduction What is emergency thoracic surgery? How is the non-elective patient disadvantaged? Enhanced

More information

Constipation An Overview. Definition Physiology of GI tract Etiology Assessment Treatment

Constipation An Overview. Definition Physiology of GI tract Etiology Assessment Treatment CONSTIPATION Constipation An Overview Definition Physiology of GI tract Etiology Assessment Treatment Definition Constipation = the infrequent passage of hard feces Definition of Infrequent The meaning

More information

Enhanced Recovery after Surgery Guideline

Enhanced Recovery after Surgery Guideline Administrative Office: 600 University Ave, 449 Toronto, ON M5G 1X5 T: 416.586.4800 x8534 F: 416.586.8644 E: epearsall@mtsinai.on.ca W: www.bpigs.ca Steering Committee Robin McLeod, Chair Mount Sinai Hospital

More information

Small Bowel and Colon Surgery

Small Bowel and Colon Surgery Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions

More information

Role of Alvimopan (Entereg) in Gastrointestinal Recovery And Hospital Length of Stay After Bowel Resection

Role of Alvimopan (Entereg) in Gastrointestinal Recovery And Hospital Length of Stay After Bowel Resection Role of Alvimopan (Entereg) in Gastrointestinal Recovery And Hospital Length of Stay After Bowel Resection Shan Wang, PharmD, RPh; Neal Shah, PharmD Candidate; Jessin Philip, PharmD, RPh; Tom Caraccio,

More information

EFFECT OF AN ENHANCED RECOVERY AFTER SURGERY PROGRAM ON OPIOID USE AND PATIENT-REPORTED OUTCOMES

EFFECT OF AN ENHANCED RECOVERY AFTER SURGERY PROGRAM ON OPIOID USE AND PATIENT-REPORTED OUTCOMES EFFECT OF AN ENHANCED RECOVERY AFTER SURGERY PROGRAM ON OPIOID USE AND PATIENT-REPORTED OUTCOMES Obstetrics & Gynecology Vol. 132, No. 2, August 2018 KUSMW OBGYN Journal Club Thomas Greaves, MD, PGY4 August

More information

A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery

A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery Tripurari Mishra MD, Deepa Bhat MD, Mina Saeed MD, Jan Kaminski MD, Mihaela Banulescu

More information

BJF Acute Pain Team Formulary Group

BJF Acute Pain Team Formulary Group Title Analgesia Guidelines for Acute Pain Management (Adults) in BGH Document Type Issue no Clinical guideline Clinical Governance Support Team Use Issue date April 2013 Review date April 2015 Distribution

More information

Nasogastric Tube Decompression in Stomach and Small Bowel Surgery

Nasogastric Tube Decompression in Stomach and Small Bowel Surgery Original Article Nasogastric Tube Decompression in Stomach and Small Bowel Surgery Pokharel N,* Adhikari S,** *Resident, ** Professor, NAMS Bir Hospital, Kathmandu, Nepal ABSTRACT: INTRODUCTION: The use

More information

Colorectal Clinical Pathways: A Method of Improving Clinical Outcome?

Colorectal Clinical Pathways: A Method of Improving Clinical Outcome? Original Article Colorectal Clinical Pathways: A Method of Improving Clinical Outcome? Jane J.Y. Tan, Angel Y.Z. Foo and Denis M.O. Cheong, Department of General Surgery, Tan Tock Seng Hospital, Singapore.

More information

COLORECTAL RESECTIONS

COLORECTAL RESECTIONS COLORECTAL RESECTIONS What is a colorectal (bowel) resection? Surgery to remove a part of the large bowel is called a resection. Different parts of the colon require different operations and have different

More information

Nutritional Support in the Perioperative Period

Nutritional Support in the Perioperative Period Nutritional Support in the Perioperative Period Topic 17 Module 17.3 Nutritional Support in the Perioperative Period Ken Fearon Learning Objectives Understand the principles behind nutritional care for

More information

Click to edit Master subtitle style

Click to edit Master subtitle style Does Enhanced Recovery Improve Outcomes? Click to edit Master subtitle style Kaare Weber, MD Director of Surgery Associate Medical Director, Surgery A MEMBER OF THE MONTEFIORE HEALTH SYSTEM mes? Click

More information

A high-volume surgical unit experience with enhanced recovery after surgery (ERAS)

A high-volume surgical unit experience with enhanced recovery after surgery (ERAS) A high-volume surgical unit experience with enhanced recovery after surgery (ERAS) Catalina Mosquera, Nicholas J. Koutlas, Nasreen A. Vohra, Emmanuel E. Zervos, Timothy L. Fitzgerald East Carolina University,

More information

FTS Oesophagectomy: minimal research to date 3,4

FTS Oesophagectomy: minimal research to date 3,4 Fast Track Programme in patients undergoing Oesophagectomy: A Single Centre 5 year experience Sullivan J, McHugh S, Myers E, Broe P Department of Upper Gastrointestinal Surgery Beaumont Hospital Dublin,

More information

Impact of Preoperative Bowel Preparation on the Risk of Clostridium Difficile after Colorectal Surgery: A Propensity Weighted Analysis

Impact of Preoperative Bowel Preparation on the Risk of Clostridium Difficile after Colorectal Surgery: A Propensity Weighted Analysis Impact of Preoperative Bowel Preparation on the Risk of Clostridium Difficile after Colorectal Surgery: A Propensity Weighted Analysis Ebram Salama, MD PGY-3 General Surgery Sir Mortimer B. Davis Jewish

More information

Karen Lok Man Tung, Michael Ka Wah Li. Introduction

Karen Lok Man Tung, Michael Ka Wah Li. Introduction Original Article Page 1 of 5 Hybrid natural orifice transluminal endoscopic surgery colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors: intermediate follow up of a randomized

More information

Colorectal Liver Metastases Metachronous

Colorectal Liver Metastases Metachronous Colorectal Liver Metastases Metachronous Professor Rowan Parks Professor of Surgical Sciences University of Edinburgh No disclosures Natural History of Unresected Untreated Colorectal Metastases Year N

More information

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2018;21(1):38-42 Journal of Minimally Invasive Surgery Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic

More information

With joy and great relief

With joy and great relief Ulf Gustafsson All previously published papers and figures were reproduced with permissions from the publishers Published by Karolinska Institutet Printed by Larserics Digital Print AB Ulf Gustafsson,

More information

Elderly Man With Chronic Constipation

Elderly Man With Chronic Constipation Elderly Man With Chronic Constipation Linda Nguyen, MD Director, Neurogastroenterology and Motility Clinical Assistant Professor Stanford University Overview Normal bowel function Defining Constipation:

More information

Patient Presentation. 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201

Patient Presentation. 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201 Patient Presentation 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201 CT shows: Thickening of the right hemidiaphragm CT shows: Fluid in the right paracolic sulcus CT shows: Large

More information

Enhanced Recovery After Surgery: Where Do Pharmacists Come In?

Enhanced Recovery After Surgery: Where Do Pharmacists Come In? Enhanced Recovery After Surgery: Where Do Pharmacists Come In? Melinda C. Joyce, Pharm.D., FAPhA, FACHE Vice President, Corporate Support Services Med Center Health Bowling Green, Kentucky Annual Meeting

More information

Postoperative pain management: Analgesics, algorithms and patient activation

Postoperative pain management: Analgesics, algorithms and patient activation Postoperative pain management: Analgesics, algorithms and patient activation Alfred Deakin Prof. Mari Botti Deakin University/Epworth HealthCare Victorian Perioperative Nurses Group 60 th State Conference,

More information

Opioid constipation treatment dulcolax

Opioid constipation treatment dulcolax P ford residence southampton, ny Opioid constipation treatment dulcolax Posts about how to relieve constipation instantly written by gbrese1958. Official Web site for MOVANTIK (naloxegol) tablets, for

More information

Nursing Management Plan Small or large bowel

Nursing Management Plan Small or large bowel Nursing Management Plan Small or large bowel Highlight the procedure/s and add other details: Open / Laparoscopic Assisted Hemicolectomy / Right / Left / Extended Sigmoid Colectomy / Transverse Colectomy

More information

Motility Disorders. Pelvic Floor. Colorectal Center for Functional Bowel Disorders (N = 701) January 2010 November 2011

Motility Disorders. Pelvic Floor. Colorectal Center for Functional Bowel Disorders (N = 701) January 2010 November 2011 Motility Disorders Pelvic Floor Colorectal Center for Functional Bowel Disorders (N = 71) January 21 November 211 New Patients 35 3 25 2 15 1 5 Constipation Fecal Incontinence Rectal Prolapse Digestive-Genital

More information